Health and Disability

That doctors receive big money from the pharmaceutical industry is no surprise. The new data released by the Centers for Medicare and Medicaid Services shows that such interactions are widespread, with not only doctors, but thousands of dentists, optometrists, podiatrists and chiropractors receiving at least one industry payment from August 2013 to December 2014.

What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.

The team established for the first time the molecular and functional mechanism by which adult patients with autoimmune diseases, particularly systemic lupus erythematosus, Sjogren's syndrome, and other connective tissue diseases (CTD), including mixed CTD, undifferentiated CTD, polymyositis/dermatomyositis, systemic sclerosis, and rheumatoid arthritis, develop abnormal electrical activity on their electrocardiogram (ECG) known as Long QT syndrome or QT interval prolongation.

Long QT prolongation can be inherited due to abnormal genes or acquired, often due to medication side effects, all of which affect the heartbeat cycle in a way that increases the risk of irregular heartbeat episodes that originate from the ventricles. These episodes may lead to palpitations, fainting, and sudden death due to ventricular fibrillation.

"We discovered that antibodies called anti-SSA/Ro antibodies picked up in laboratory testing and found in adult patients with connective tissue diseases actually block a specific cardiac channel (called the hERG channel), preventing potassium ions from going out of the cell and resulting in abnormal ECG (Long QT). The concern is that patients with these 'bad' antibodies can be at risk for even worse heartbeat abnormalities if their electrolytes are abnormal or if they are taking medications such as some anti-histamine or anti-depressant drugs known to cause Long QT on their own," explains Dr. Boutjdir.

Øystein Fluge and Olav Mella of the Haukeland University Hospital in Bergen noticed its effect on CFS symptoms in 2004, when they used the drug to treat lymphoma in a person who happened to also have CFS. Several months later, their CFS symptoms had disappeared. A small, one-year trial in people with CFS in 2011 found that two-thirds of those who received rituximab experienced relief, compared with none of the control group.

The most recent study, involving 29 people with CFS, shows that repeated rituximab infusions can keep symptoms at bay for years (PLoS One, DOI: 10.1371/journal.pone.0129898). "Eleven of the 18 responders were still in remission three years after beginning the treatment, and some have now had no symptoms for five years," says Fluge. "Suddenly, their limbs started to work again and their hands were no longer cold or sweaty."

The researchers think antibodies are to blame in at least a proportion of people with CFS. Relief started four to six months after the first dose of rituximab, approximately the time it would take for existing antibodies to be cleared from the body. Participants relapsed after about a year – roughly how long B-cells take to regrow and start making new antibodies. "We think the pattern of responses and relapses involves some mechanism with these antibodies," says Fluge.

Detecting the change in water temperature is something you can do without thinking, but for those with Alzheimer’s they lose this ability according to the Alzheimer’s Association. Consequently, they can become burned when the water is too hot. To prevent burns, it is recommended to set the hot water temperature at 120^oF or lower.

Though there hasn’t been definitely research showing a link between Alzheimer’s and an increased risk of drowning, an Internet search does yield stories of dementia patients who wandered away and drowned. Yet your loved one doesn’t have to wander away from home to face the hazards of being unsupervised around water. The Alzheimer’s Association says that “even the most basic appliance or household object can become dangers,” including kitchen or bathroom sinks. Because of forgetfulness, seniors may forget to turn off the water, resulting in a flooded bathroom. They may also slip getting into a tub or shower . To safeguard against these scenarios, reducing the water flow will prevent floods while allowing your loved one their independence of washing when they need to. Installing a non-slip mat in the shower or bathtub will prevent falls.

An old study from from 1954 to 1964 presented data data in England on paraplegics. They said, "The results where no catheterisation or only intermittent catheterisation had been used by the referring hospital are superior to those where a Gibbon catheter was used and infinitely superior to those where a Foley catheter was used."

They did not use p-values (maybe that was not the standard in those days?), but if you run the math based on the data in the article, you find that the rate of bacteriuria is 0% in the no catheter group, 7.5% in the intermittent catheter group, and 60.9% in the Foley catheter group!   

In a more recent study, a group at Brown University (Rhode Island Hospital) did a review of the trauma registry at their Level 1 trauma center from 2003 to 2008, which included over 5,700 patients. They found that after controlling for other factors like injury severity, diabetes, age, etc, patients with a UTI (who comprised 11.9% of the patients) had an in-hospital mortality of 9.6%, significantly higher than those patients without a UTI (3.5%, p < 0.001).

“We have almost 2,000 brick-and-mortar home health agencies in California, handling caregivers, marketing people, staffing, managing lists of caregivers,” he says. “It seems obvious that some technology company is going to address the inefficiencies.”

HomeHero accepts about 12% of caregiver applicants, he says, and they usually come from schools and accreditation organizations. They go through a 15-point online screening, a phone interview, and an orientation session/in-person interview. This is recorded in high-definition video and posted to the HomeHero website. These videos are another way HomeHero stands out, and they give would-be clients another tool in making their hiring decision, Townsend says.

The system is adaptable, he emphasizes.

“Some families know what they want, so they go online and choose someone, and send a job request out,” he says. “Some are going through this for the first time and want to talk to someone, so we have a team that is trained in how to hire a caregiver.”

About 50% of HomeHero users take advantage of the team consultations, he estimates.

Once a client and caregiver are matched, there is a review system to further build trust and transparency, he says. While the caregivers are hired directly by the client or families, HomeHero is insured for up to $1 million in theft protection and $2 million in professional liability coverage.

In 2014, seniors nationwide made more than 271,200 requests for assistance from the Eldercare Locator, a referral service providing information about care resources available in communities around the country. 

The average caller is age 60 or older, is a first-time caller and— while the organization was originally conceived as a service for caregivers—over 70% of those contacting the center are reaching out on their own behalf, according to the 2014 Eldercare Locator Data Report: A Snapshot of Older Adult Issues & Needs in America.

“As people age, services that enable them to continue to live independently in their homes tend to be the first outside resources they seek out,” the report said. 

Of those who contacted the center in 2014, 18% were seeking information about home and community-based services, just below 19% of seniors seeking transportation assistance, data show.

Of those seeking home and community-based services, 38.6% expressed a need for help with chores; 35.4% expressed a need for help with personal care; 11.8% needed case management services; 11.6% needed home health care; and 2.6% needed financial assistance for services.

“Home-delivered meals, personal care, chore services and home maintenance are just a few of the services requested,” the report notes. “Unfortunately, inadequate funding for these programs means that too many older adults will struggle to access the services and supports they need.”